Clearinghouse Services Status

Last updated: 12/17/24 10:30 AM EST 

A cyberattack against Change Healthcare caused all clearinghouse services to be shut down on 2/21/24. TherapyNotes has migrated claims and ERA features to CLAIM.MD, and we now fully support sending claims and receiving ERAs.

Can I send Claims now?

Yes, TherapyNotes can now send electronic claims to any payer in our payer list whether or not they require enrollment, assuming your enrollment has been completed.

Can I send claims to payers that require enrollment? Why are my claims stuck as “Pending”? And what is enrollment anyway?

Some payers require you to complete paperwork in order to send claims from a new clearinghouse. This is separate from ERA enrollment, which is always required. Do not confuse enrollment with credentialing. Credentialing with a payer means going in network with them.

The enrollment process for sending claims is quick and easy for most payers. There is a new streamlined process built into TherapyNotes to take these steps. This is significantly easier than what was required with Change Healthcare.

The TherapyNotes payer list has been updated to the CLAIM.MD payers and payer IDs instead of Change Healthcare's payer list. For new payer enrollments, submitted claims may initially sit in ‘Pending’ status for 72 hours to give your new enrollment request enough time to complete.

For questions on the new enrollment process, contact our enrollment support team at (215) 658-4550, option 4. Please do not contact CLAIM.MD directly for enrollment support. They are not able to assist and will direct you back to our TherapyNotes Support team.

How do I enroll if my practice has multiple clinicians with their own tax ID and group NPI?

The self-enrollment feature in TherapyNotes uses the practice's tax ID and group NPI from the practice settings. If you have a practice account shared by multiple clinicians (known as co-op practices) with their own tax ID and group NPI (such as in the clinician settings billing overrides), you will need to contact our enrollment team at (215) 658-4550, option 4, to help you complete your enrollment. 

PO Box Rejections

We are seeing many rejections due to the presence of a PO box in the address. If you see this rejection reason you need to remove your PO Box from Practice Information, Multiple Practice Locations, and Clinician Billing Setting Overrides. Instead you can put a PO Box in Alternate Billing Address in Practice Billing Settings.

Payer Specific Updates

• Cigna: Cigna ERAs were not coming in for the past couple weeks, but we are now receiving them again. (5/10)
• FrontPath Health Coalition (34171): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (5/10)
  
• Planned Administrators - Non Preferred Blue Providers (37287): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (5/6)
• ProviDRs Care Network (48100): You may have received rejections that state "WP481 Site is not allowed to send claims to the specified payer". The connection to this payer has been restored and you can resubmit these claims. (5/6)
• Alicare (13550): It has been determined this payer requires Change Healthcare to process claims. While CLAIM.MD looks for an alternative connection route with this payer, you may receive rejections that state "Rejected, Claim Reason:Missing or invalid information. Additional Details: Code 21 - Entity's id number., PAYER ID IS EXPIRED {5403}". (5/1)
  
• Advantek Benefit Administrators (83077): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (4/29)
  
• HealthPlan Services (59140): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (4/26)
• Employee Benefits Plan Administration, Inc. (03036): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (4/24)
• Passport Advantage (66008): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (4/23)
• Indiana ProHealth Network (35161): This payer was previously not accepting claims because they were dependent on Change Healthcare. They are now accepting claims again. (4/23)
• Mississippi Physicians Care Network (64084): This payer was previously not accepting claims because they were dependent on Change Healthcare. They are now accepting claims again. (4/23)
  
• Southeastern Indiana Health SIHO (77153): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (5/30)
• Managed Care Services, LLC (35162): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (6/7)
• Western Southern Financial Group (31048): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER". The connection to this payer has been restored and you can resubmit these claims. (6/7)

• Capital Blue Cross (Payer ID 23045) now requires enrollment, even if you were previously submitting claims successfully. This change is already in effect within TherapyNotes, so practices will be prevented from submitting any further claims to this payer until they have completed enrollment. For more help completing these steps, read Enroll to Submit Claims.

• Pittsburgh Care Partnership Inc (Payer ID 23283) now requires re-enrollment (ERA REENROLLMENT). To do so, the practice will need to access their completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.

• Lucent Health (88056): You may have received rejections that state "DUE TO THE RECENT CYBERSECURITY INCIDENT, THERE IS NOT CURRENTLY AN ELECTRONIC PATH AVAILABLE FOR THIS PAYER" or "Entit's id number, PAYER ID IS EXPIRED". The connection to this payer has been restored and you can now resubmit these claims. (6/19). 
  
• Highmark BCBS DE Heath Options Inc (Payer ID 47181) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the "re-enroll" button. (7/2) For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.
• Health Alliance Plan of Michigan (Payer ID 38224) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.  (7/3) 
• Horizon NJ Health (Payer ID 22326) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.
• 1199 National Benefit Fund (Payer ID 13162) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.
• Oscar Health (Payer ID OSCAR) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.
• Martins Point Health Care (Payer ID 53275) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.
• As of 8/1/24, Aetna (Payer ID 60054) is no longer processing the temporary paper ERA enrollment forms made available during the Change Healthcare service interruption.If you already received confirmation from Aetna that your ERA enrollment is complete, there is nothing else for you to do. If you previously submitted the paper enrollment form and have not received confirmation from Aetna of your ERA enrollment, then you will need to re-enroll.To re-enroll, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button and follow the new steps provided. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice."
• Health Services for Children with Special Needs (Payer ID 37290) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice. (8/14) 
• AlohaCare (Payer ID ALOHA) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the "re-enroll" button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice. (8/20) 
• The Health Plan (Payer ID 95677) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.
  
• On 8/28/24, we sent a notification indicating that WPS Tricare ERA re-enrollment was required for the following payers:
  
  • TRICARE for Life, Payer ID: TDFIC
  • East Region, Payer ID: TREST
  • TRICARE Overseas, Payer ID: SX163
    Please disregard that message. CLAIM.MD has confirmed with WPS that the enrollment process for these payers remains unchanged, and enrollments will continue to use the existing payer enrollment services. We apologize for any confusion created. No action is required from you at this time. 
• 11/21/24: 1199 National Benefit Fund (Payer ID 13162) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button.
  For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.
  • Information from the payer's website regarding the change
    https://www.1199seiubenefits.org/providers/claims/. The Benefit Funds have selected Zelis for electronic payment and electronic remittance advice distribution, starting 11/1/24.  
    
• 12/17/24: Alignment Healthcare (Payer ID AHCA1) now requires re-enrollment to continue receiving ERAs. To do so, access your completed ERA enrollment from the payer page, open the new window, and click the “re-enroll” button. For more help on completing these steps, read Enroll to Receive Electronic Remittance Advice.

Payers that Require Change Healthcare 

A number of payers that are dependent on Change Healthcare have not yet been restored by CHC and are therefore unable to receive claims. CLAIM.MD will now reject electronic claims to these payers until the payer is restored by CHC and is able to receive electronic claims. Until then, only paper claims are available for these payers. As connections are restored, we will update the list. 

The clearinghouse will still print and mail these claims for you - simply update the payer to remove the Payer ID and provide a mailing address. When you submit the claim from the Submit Electronic Claims page, a paper CMS-1500 form will be mailed to the payer for you. See our recent What's New for more information. Alternatively, you can print and mail the CMS-1500 form yourself. Visit our help article for more information. 

Why aren't I getting ERAs? What happens to old ERAs I didn’t get?

TherapyNotes is receiving ERAs from CLAIM.MD and Change Healthcare. Enrollment is required, even if you were previously enrolled with Change Healthcare. In many cases, this is as simple as clicking a button. Sometimes, there is paperwork to complete, which is streamlined within TherapyNotes (No printing or faxing required). In some cases, you will be given instructions to follow on the payer’s website.

Change Healthcare is now sending us a backlog of old ERAs as well.

Some payers may be agreeable to resend ERAs to you. Practices are encouraged to call payers to make this request, but not until after you are enrolled to receive ERAs from CLAIM.MD.

Can I do eligibility checks or mail paper claims?

We’ve restored the ability to submit paper claims for the clearinghouse to print and mail on your behalf. To learn more about this feature, read our latest What’s New. 
We are continuing our efforts to restore eligibility check functionality.